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Mindfulness Meditation for Insomnia

Mindfulness Meditation for Insomnia

Insomnia is the most commonly reported sleep disorder in the United States. The estimated 10% of adults affected by insomnia generally experience poor health outcomes and poor quality of life. Available treatment options include pharmacotherapy and cognitive behavioral therapy for insomnia (CBT-I). Pharmacotherapy can be complicated due to tolerance issues and the potential risk of side-effects. In addition, access to CBT-I is limited because only a small number of providers are trained to provide it. Recent studies have indicated that mindfulness meditation may be a simple, effective, and safe adjunct to traditional treatment for patients with insomnia.   Analyzing Mindfulness Meditation Mindfulness meditation has been defined as the awareness of the present moment with attitudes of acceptance and openness. It aims to allow those who practice it to respond to stimuli in a non-judgmental manner and let go of certain beliefs, thoughts, or emotions that may cause distress. Mindfulness meditation can also help reduce the number of emotionally arousing or harmful conditioned responses. This can be particularly useful in patients with insomnia because this population is thought to be hyper-aroused and to experience mind-racing and ruminations when trying to fall asleep. “There are logical reasons to consider mindfulness meditation as a treatment for insomnia,” write Joanne S. Martires, MD, Michelle Zeidler, MD, and colleagues in a literature review published in Current Opinion in Pulmonary Medicine. “Letting go, acceptance, and non-striving are principles in mindfulness meditation that are congruent with stimulus control.” There are two ways in which mindfulness meditation is currently being used to help insomnia patients, explains Dr. Martires. The first is mindfulness-based stress reduction (MBSR), which focuses...

Hypnotics, Elderly, & the Risk of Falls

Research has shown that the prevalence of insomnia increases with age. The appropriate treatment of insomnia in older patients can be challenging for several reasons, including the prevalence of comorbid conditions, increased use of a variety of medications (espe­cially central nervous system active compounds), and a compromised ability to metabolize and/or excrete these medications. This compromised function has typically resulted in lower recommended doses for many therapies, especially for hypnotic agents for which starting doses for the elderly are often half or less than those for adults. The purpose of using lower doses is to minimize adverse events (eg, amnestic effects or residual sedation) and thereby maxi­mize daytime functioning and patient safety. “Minimizing the risks of falls and fall-related injuries is a paramount consideration in the treatment of insomnia in the elderly.” An important consideration for safety in the elderly popula­tion is the risk for falls and fall-related injuries. A recent article by Frey et al in the Journal of the American Geriatrics Society evaluated the effect of sleep inertia on balance and cognition during nighttime awakenings in both adults and the elderly. The authors found that zolpidem produced clinically significant balance and cognitive impairments upon awakening from sleep. However, the study did not directly evaluate the incidence of falls; instead, it used the results of performance on tandem walking as a predictor of falls. These tandem walks occurred 120 minutes after a scheduled sleep opportunity and, thus, were designed to test the effects of zolpidem and sleep inertia in the first half of the night when those effects would be greatest. While the study is methodologically sound, it...

Conference Highlights: CHEST 2010

The CHEST 2010 annual meeting offers clinical instruction in pulmonary, critical care, and sleep medicine. These features include research presented on diabetes drugs fighting lung cancer progression, how diet impacts COPD, and the role of electronic media in daytime function and sleep disorders. » Diabetes Drugs May Fight Lung Cancer Progression » Diet Impacts Lung Function in COPD » Electronic Media, Daytime Function, & Mood in Teens Diabetes Drugs May Fight Lung Cancer Progression The Particulars: Previous research has suggested an association between metformin and/or thiazolidinedione (TZD) use and the risk of developing lung cancer. A study was conducted to determine the influence of metformin and TZDs on lung cancer presentation and course. Data Breakdown: Researchers reviewed the medical records of 157 patients with diabetes who had a history of lung cancer. Patients who were exposed to either metformin or TZDs were significantly less likely to have metastatic disease (20.0% vs 42.4%) or a small cell or squamous cell carcinoma. They also demonstrated improved survival (hazard ratio, 0.56). There were no significant differences between the age, sex, and smoking histories of the group exposed to metformin or TZDs prior to their lung cancer diagnosis. Take Home Pearl: Use of metformin and/or TZDs appears to lower risks of advanced lung cancer. These medications also correlated with an improved survival rate among patients with diabetes who developed concomitant lung cancer. Diet Impacts Lung Function in COPD [back to top] The Particulars: The role antioxidants play in lung function in patients with COPD is unclear. A study was conducted to assess the role of antioxidants with regard to lung function in men and women with COPD. Data...
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